As clinical trials for covid-19 vaccines begin to produce sufficient evidence to begin the regulatory approval process and scale-up manufacture, governments, especially in the UK, face a whole range of new challenges. Many will resemble those of the earlier phases of the pandemic and will be shaped by the experience of managing the first peak and the subsequent attempts to implement a test, trace and isolate programme.
Two problems need to be resolved to ensure the successful rollout of the vaccine. The first is simply coverage. Depending upon efficacy, 50-75% of the population needs to be vaccinated to ensure community level protection. As a report this week from the Royal Society and the British Academy demonstrates, this level of coverage could be missed if vaccine hesitancy is as widespread as surveys indicate it could be. 9% of respondents claim they are very unlikely to accept a vaccine, while 27% are uncertain. Although troubling, this is far below the level of risk in the US, where the figures rise to 20% and 31% respectively.
Western governments are unlikely to impose mandatory vaccination, but will, therefore, need to invest time and resources in effective communications programmes to encourage uptake. This is complicated by the politicisation of the covid response and dwindling levels of trust in the government’s approach. As highlighted by the Royal Society and British Academy, an open and transparent dialogue with the public is vital and although there have been missteps previously on the use of data and the timings, announcement and expectations for various covid containment measures, the UK prime minister, Boris Johnson, set an appropriately cautious tone when responding to preliminary results from the Pfizer/BioNTech vaccine candidate.
A novel feature of this challenge will be how misinformation is spread via social media and how social media platforms respond. Several have taken a far more robust approach to countering unevidenced claims surrounding the outcome of the US elections. The UK government has already been working on similar measures relating to covid-19 and has struck an agreement with the major platforms to ensure that at least there are no commercial incentives to promote anti-vax content. An unknown factor is how social media users will react to such an approach and in particular whether this will be perceived as suppression of crucial information by government and social media on behalf of vested interests.
A greater challenge is arguably that of vaccine distribution and administration. Government has struggled with coordinating complex workstreams such as PPE distribution and test and trace; the complexity of delivering a multi-dose vaccine that requires ultra-low temperature storage is arguably even greater. This is firmly linked to government comms and expectation management. As leading UK government advisory Prof Sir John Bell stated today, the bulk of vulnerable groups could be vaccinated by Easter ‘provided they don’t screw up the distribution of the vaccine.’
Government faces some critical choices on how to manage this distribution. How much, for example, should it rely on primary care setting, which have the knowledge and expertise to manage the programme, but are overstretched and already having to deal with a larger flu vaccination rollout? Can sufficient staff be sourced and trained for vaccine administration? How much will policymakers be tempted by the apparent efficiency of centralised mass sites and roving teams, which the Royal Society and British Academy consider to be less effective? How can employers and community groups be integrated into the process to improve trust? How will it select commercial partners and how can they be managed to reduce reputational risks? What risks are there for importing vaccines from the continent after Brexit?
On top of managing these challenges, the government will have to modulate its economic support policies. This relies on gaining a better understanding of how vaccination reduces covid transmission risk, bearing in mind that it may be some months before community transmission can be eliminated. Those sectors of the economy reliant on mass indoor gatherings, for example, may have some time to wait before restrictions are lifted. This is an unenviable task to manage, especially as announcements of vaccine approval (but not rollout) in the midst of a second wave could have unintended and counterproductive effects on public behaviour. This last unknown should worry government the most. With a population already tired of covid restrictions and eager for a normal Christmas, the imminent promise of vaccine salvation may prompt too many to increase their risk appetite, with devastating consequences for the NHS and the economy.